Principles of class ii treatment /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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Principles of class ii treatment /certified fixed orthodontic courses by Indian dental academy

  1. 1. PRINCIPLES OF CLASS II TREATMENT www.indiandentalacademy.comwww.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. IntroductionIntroduction Treatment of class II has a controversialTreatment of class II has a controversial historyhistory Americans – head gears and class IIAmericans – head gears and class II elasticselastics Europe – popularized – functionalEurope – popularized – functional appliancesappliances Surgical options – given new diemensionsSurgical options – given new diemensions to the treatment of adult class IIto the treatment of adult class II www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. CLASSIFICATION:CLASSIFICATION:  According to Edward H. AngleAccording to Edward H. Angle CLASS II Class II div 1 (distoocclusion with labioversion of upper incisors) Class II div 2 (disto occlusion with llinguo version of maxillary incisors) Class II div1 subdivision classII div2 subdivision www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. EXTRA ORAL FEATURESEXTRA ORAL FEATURES  CONVEX PROFILECONVEX PROFILE  INCOMPETENT LIPSINCOMPETENT LIPS  LOWER FACIAL HEIGHT,LOWER FACIAL HEIGHT, OR AVGOR AVG  DEEP MENTO LABIALDEEP MENTO LABIAL SULCUSSULCUS  ABNORMALABNORMAL MUSCULATUREMUSCULATURE • STRAIGHT TO CONVEX PROFILE • COMPETENT LIPS • LOWER FACIAL HEIGHT - DECREASED CLASS II DIV 1 CLASS II DIV 2 www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. INTRA ORAL FEATURESINTRA ORAL FEATURES  TAPERED ARCHTAPERED ARCH  UPPER ANTERIORSUPPER ANTERIORS PROCLINEDPROCLINED  OVER BITE –OVER BITE – VARIABLEVARIABLE  INCREASEDINCREASED OVERJETOVERJET • SQUARE ARCH • CENTRALS RETOCLINED, LATERALS ARE PROCLINED • DEEP OVER BITE • NORMAL TO MILD INCREASE IN OVERJET www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. Class II, subdivisionClass II, subdivision  When a class II molar relation exists on oneWhen a class II molar relation exists on one side and a class I relation on the other, it isside and a class I relation on the other, it is referred to as class II subdivision.referred to as class II subdivision. Based on whether it is a division 1 or divisionBased on whether it is a division 1 or division 2 it can be called a class II, division 1,2 it can be called a class II, division 1, subdivision or a class II, division 2,subdivision or a class II, division 2, subdivision.subdivision. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. ETIOLOGY:ETIOLOGY: It is important to distinguish class II malocclusions thatIt is important to distinguish class II malocclusions that are primarily of genetic origin from those ofare primarily of genetic origin from those of primarily environmental when choosing theprimarily environmental when choosing the appropriate treatment andappropriate treatment and retention.retention. A.A. Genetic causesGenetic causes:: HERIDITYHERIDITY B.B. ..Environmental causes:Environmental causes: 1.1.HabitsHabits:: 2. Trauma-T M J Ankylosis2. Trauma-T M J Ankylosis Forceps deliveryForceps delivery 3.Early Exfoliation of primary molars.3.Early Exfoliation of primary molars. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. 4. Retained deciduous molars.4. Retained deciduous molars. 5. Proximal caries.5. Proximal caries. 6. Missing teeth.6. Missing teeth. 7 . Supernumerary teeth7 . Supernumerary teeth 8. Delayed eruption.8. Delayed eruption. 9. Abnormal eruptive path way.9. Abnormal eruptive path way. 10. Improper restorations.10. Improper restorations. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. TREATMENT PLANTREATMENT PLAN SKELETAL CLASS II DENTAL CLASS II MAXILLARY EXCESS MANDIBULAR DEFICIENCY COMBINATION MAXILLARY MOLARS MOVED FORWARD MESIAL IN ROTATION OF MAXILLARY MOLARS www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. SKELETAL – TREATMENTSKELETAL – TREATMENT OPTIONSOPTIONS GROWTH PRESENT GROWTH COMPLETED PRIMARY DENTITION MIXED DENTITION PERMANENT DENTITION CAMOUFLAGE SURGICAL www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. PRIMARY DENTITION(3-6Yrs)PRIMARY DENTITION(3-6Yrs) A.Space maintenance in primary molarA.Space maintenance in primary molar area.area. B.Incisor protrusion-Habit breakingB.Incisor protrusion-Habit breaking appliances are given.appliances are given. C. Antero posterior discrepancy- A distalC. Antero posterior discrepancy- A distal step has to be identified at this stage andstep has to be identified at this stage and growth modification is to be attemptedgrowth modification is to be attempted only in severe cases as continuing growthonly in severe cases as continuing growth complicates this problem.complicates this problem. www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. MIXED DENTITIONMIXED DENTITION MAXILLARY EXCESS MANDIBULAR DEFICIENCY COMBINATION VERTICAL HORIZONTAL AVERAGE SKELETAL GROWTH PATTERN www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. Maxillary prognathismMaxillary prognathism Head gears  The type of head gear is chosen according toThe type of head gear is chosen according to the growth patternthe growth pattern  Consists of the face bow, force module and theConsists of the face bow, force module and the strapstrap  The strap will differ according to the growthThe strap will differ according to the growth patternpattern  The angulation and length of the face bow canThe angulation and length of the face bow can be changed to achieve the desired moments andbe changed to achieve the desired moments and force required for a particular clinical situationforce required for a particular clinical situation www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. CERVICAL PULL HEADCERVICAL PULL HEAD GEARGEAR  Indicated in patients withIndicated in patients with decreased verticaldecreased vertical dimension.dimension.  Outer bow lies above theOuter bow lies above the plane of occlusion toplane of occlusion to direct force throughdirect force through centre of resistance andcentre of resistance and prevent distal tipping ofprevent distal tipping of the molars.the molars. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. High pull head gearHigh pull head gear  Indicated in patients with increasedIndicated in patients with increased vertical dimension.vertical dimension.  Face bow is anchored to an occipitalFace bow is anchored to an occipital anchoring unit to produce a verticallyanchoring unit to produce a vertically directing force.directing force.  High pull head gear- can redirect theHigh pull head gear- can redirect the vertical diemension of the maxilla thusvertical diemension of the maxilla thus allowing the auto rotation of the mandibleallowing the auto rotation of the mandiblewww.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. Force magnitude for HG:Force magnitude for HG: Recommended force values per sideRecommended force values per side Full permanent dentition – 400-600 gmsFull permanent dentition – 400-600 gms Early mixed dentition – 150-250 gmsEarly mixed dentition – 150-250 gms Late mixed dentition – 300-400 gmsLate mixed dentition – 300-400 gms Retention in permanent dentition – 150-Retention in permanent dentition – 150- 400 gms.400 gms. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. Head gear are tooth borne Attached to the molar tube Intermittent forces Minimizes tooth movement Provide skeletal change Less damaging to the tissue Due to the rest period  Duration:Duration: Graber, forces of 12-16 hourGraber, forces of 12-16 hour durationduration www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. Mandibular deficiencyMandibular deficiency Functional appliances is the choice ofFunctional appliances is the choice of treatment for mandibular deficiency intreatment for mandibular deficiency in growing children.growing children. Criteria for case selection are:Criteria for case selection are:  Individuals with growth potentialIndividuals with growth potential  Retrognathic mandibleRetrognathic mandible  Deep biteDeep bite  Low mandibular plane angleLow mandibular plane angle  Favourable V T OFavourable V T O  Upright lower incisorUpright lower incisorwww.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. Mandibular deficiencyMandibular deficiency Anatomical retrusion Functional retrusion Functional appliances Not favourable Occlusal prematurities Surgical option Functional appliance www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. TREATMENT FOR HORIZONTALTREATMENT FOR HORIZONTAL GROWTH PATTERNGROWTH PATTERN Short face (skeletal deep bite) class IIShort face (skeletal deep bite) class II  Obtain differential growth of the jaws such that theObtain differential growth of the jaws such that the mandible catches up with the maxilla and themandible catches up with the maxilla and the skeletal problem improves or disappears.skeletal problem improves or disappears.  Allow more eruption of the lower than the upper teethAllow more eruption of the lower than the upper teeth so that the occlusal plane rotates up posteriorly, inso that the occlusal plane rotates up posteriorly, in the direction that facilitates Class II correction, deepthe direction that facilitates Class II correction, deep bite and increase lower facial heightbite and increase lower facial height www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. Treatment optionsTreatment options Functional jaw orthopedicsFunctional jaw orthopedics Functional appliance therapy.Functional appliance therapy. Cervical headgear tends to open the biteCervical headgear tends to open the bite anteriorly. It differentially erupts the upperanteriorly. It differentially erupts the upper rather than the lower molars and does notrather than the lower molars and does not produce the desired change in orientationproduce the desired change in orientation of the occlusal plane.of the occlusal plane. Functional appliances is most useful inFunctional appliances is most useful in the treatment of short face class IIthe treatment of short face class II treatmenttreatment www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. Class II children with normal facialClass II children with normal facial height.height. May have anterior deep bite because ofMay have anterior deep bite because of excessive eruption of the lower incisors.excessive eruption of the lower incisors. Current guidelines for treatment are:Current guidelines for treatment are:  Functional jaw orthopaedics.Functional jaw orthopaedics.  Functional appliance therapy.Functional appliance therapy.  Straight-pull headgear is preferred. This reducesStraight-pull headgear is preferred. This reduces elongation of maxillary molars and better controlelongation of maxillary molars and better control the inclination of the mandibular planethe inclination of the mandibular planewww.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. The objective of treatment are:The objective of treatment are: 1.1. Restriction of the forward maxillary growthRestriction of the forward maxillary growth 2.2. Inhibition of the mesial and verticalInhibition of the mesial and vertical displacement of the maxillary teeth.displacement of the maxillary teeth. 3.3. Improvement of the mandibular horizontalImprovement of the mandibular horizontal growth.growth. 4.4. Condylar and glenoid fossa remodelling.Condylar and glenoid fossa remodelling. 5.5. Improvement in muscle pattern.Improvement in muscle pattern. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. Treatment optionsTreatment options Functional jaw orthopaedicsFunctional jaw orthopaedics Functional appliance therapy.Functional appliance therapy. High pull head gear to a maxillary splintHigh pull head gear to a maxillary splint is used as it controls the eruption of theis used as it controls the eruption of the teeth.teeth. Eruption of lower teeth is controlledEruption of lower teeth is controlled most readily with interocclusal bite blocks.most readily with interocclusal bite blocks. www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. Vertically-directed extraoral force to theVertically-directed extraoral force to the functional appliance gives better control offunctional appliance gives better control of maxillary growth, so the most effectivemaxillary growth, so the most effective treatment is a combination of a functionaltreatment is a combination of a functional appliance with bite blocks and high-pullappliance with bite blocks and high-pull headgear.headgear. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES ““A functional appliance harnesses naturalA functional appliance harnesses natural forces which it transmits to the teeth andforces which it transmits to the teeth and alveolar bone in a pre determined direction”.alveolar bone in a pre determined direction”. (White, Gardiner, Leighton)(White, Gardiner, Leighton) .. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. FUNCTIONAL APPLIANCES Removable functional -preferred during the early mixed dentition Fixed functional- Preferred during the permanent dentition www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. Long face(skeletal open bite)Long face(skeletal open bite)  Characterized by excessive anterior facialCharacterized by excessive anterior facial height.height. Major diagnostic criteria:Major diagnostic criteria:  Short mandibular ramus.Short mandibular ramus.  Rotation of palatal plane down posteriorlyRotation of palatal plane down posteriorly Typical growth pattern showsTypical growth pattern shows  Vertical growth of maxilla often posteriorly thanVertical growth of maxilla often posteriorly than anteriorly.anteriorly.  Downward-Backward rotation of the mandibleDownward-Backward rotation of the mandible and an excessive eruption of maxillary andand an excessive eruption of maxillary and mandibular teeth.mandibular teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. REMOVABLE FUNCTIONALREMOVABLE FUNCTIONAL Removable Functional appliancesRemovable Functional appliances used in the treatment of class IIused in the treatment of class II malocclusion.malocclusion.  ACTIVATORACTIVATOR  BIONATORBIONATOR  FRANKEL APPLIANCEFRANKEL APPLIANCE  TWIN BLOCKTWIN BLOCK  THE MODIFIED BASS APPLIANCETHE MODIFIED BASS APPLIANCE  MANDIBULAR GROWTH APPLIANCEMANDIBULAR GROWTH APPLIANCE  MAGNETIC FUNCTIONAL SYSTEMMAGNETIC FUNCTIONAL SYSTEM www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. ACTIVATORACTIVATOR Introduced by Viggo Andreson in theIntroduced by Viggo Andreson in the year 1908.year 1908. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. Mode of action of activator: (Mode of action of activator: ( Aus-Aus- Ortho-1985-March Graeme. L. Roberts)Ortho-1985-March Graeme. L. Roberts)  Re-education of musculature.Re-education of musculature.  Lateral pterygoid muscle stimulationLateral pterygoid muscle stimulation (LPM).(LPM).  Unloading of the mandibular condyle.Unloading of the mandibular condyle.  Transduction of viscoelastic force.Transduction of viscoelastic force.  Differential eruptions.Differential eruptions. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. Antero-posterior effects ofAntero-posterior effects of activator:activator:  A forward displacement of the lowerA forward displacement of the lower arch.arch.  A distal movement of maxillary arch.A distal movement of maxillary arch.  An inhibition of the forward growth of theAn inhibition of the forward growth of the maxilla.maxilla.  A stimulation of condylar growth.A stimulation of condylar growth.  A remodelling of the mandibular fossa.A remodelling of the mandibular fossa.  An elimination of interferences.An elimination of interferences. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. The vertical effects:The vertical effects: Successful overbite reduction found to beSuccessful overbite reduction found to be accompanied by:accompanied by:  Inhibition of lower incisor eruption.Inhibition of lower incisor eruption.  Facilitation molar eruption.Facilitation molar eruption.  Encouragement of forward mandibularEncouragement of forward mandibular rotation.rotation.  An increase in lower face height.An increase in lower face height. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Treatment Effect Of Mandibular ProtrusiveTreatment Effect Of Mandibular Protrusive Appliance On The Glenoid Fossa For Class IIAppliance On The Glenoid Fossa For Class II Correction.Correction. Katsavrias et alKatsavrias et al -A. O. 2004-A. O. 2004 The glenoid fossa does not change in morphology radiographically. Glenoid fossa does not appear radiographically to contribute positive growth modifications to the class II correction by active bone modeling.www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Combination Headgear-ActivatorCombination Headgear-Activator (JCO 1984 DR. HERMAN VAN BE)(JCO 1984 DR. HERMAN VAN BE) The headgear-activator has the followingThe headgear-activator has the following modes of action:modes of action: 1. Intrusion and retraction of upper front1. Intrusion and retraction of upper front teethteeth 2. Distalization of upper molars2. Distalization of upper molars 3. Maxilla retraction3. Maxilla retraction 4. Mandibular growth stimulation,4. Mandibular growth stimulation, especially in the brachyfacial groupespecially in the brachyfacial group www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. 5. Opening of the facial axis in the5. Opening of the facial axis in the brachyfacial groupbrachyfacial group 6. Maintenance of the facial axis in the6. Maintenance of the facial axis in the dolichofacial groupdolichofacial group 7. Minor, if any, tilting of lower incisors7. Minor, if any, tilting of lower incisors 8. Stopping lower incisor eruption8. Stopping lower incisor eruption 9. Stopping the descent of the palate9. Stopping the descent of the palate www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Stability of class II div 1 treatment with the head gear-Stability of class II div 1 treatment with the head gear- activator combinationactivator combination Guilherme and associatesGuilherme and associates A. O. 2004A. O. 2004 Results of their studyResults of their study  Sagittal position of both the maxilla andSagittal position of both the maxilla and the mandible was stable in the long term.the mandible was stable in the long term.  A slight relapse of the maxillo-mandibularA slight relapse of the maxillo-mandibular relation correction occurred, probablyrelation correction occurred, probably because the maxilla resumed its normalbecause the maxilla resumed its normal development and the mandible showed adevelopment and the mandible showed a growth rate significantly smaller.growth rate significantly smaller. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. BIONATOR: Introduced byBIONATOR: Introduced by Baltors in 1960Baltors in 1960 www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. PrinciplesPrinciples The essential part of Balters concept is the roleThe essential part of Balters concept is the role of theof the tonguetongue.. ““The equilibrium between the tongue andThe equilibrium between the tongue and cheeks, especially between the tongue and lipscheeks, especially between the tongue and lips in the height, breadth and depth in an oralin the height, breadth and depth in an oral space of maximum size and optimal limits,space of maximum size and optimal limits, providing functional space for the tongue ,isproviding functional space for the tongue ,is essential for the natural health of the dentalessential for the natural health of the dental arches and their relation to each other”arches and their relation to each other” www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. Aims of RxAims of Rx :: 1.1. Accomplish lip closure and establishAccomplish lip closure and establish contact b/w back of the tongue and softcontact b/w back of the tongue and soft palatepalate 2.2. Enlarge oral spaceEnlarge oral space 3.3. Incisors in edge to edgeIncisors in edge to edge 4.4. Elongation of the mandibleElongation of the mandible 5.5. Leading to an improved relationship b/wLeading to an improved relationship b/w the jaws, tongue, dentition and soft tissuesthe jaws, tongue, dentition and soft tissues www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Skeletal, Dentoalveolar and Soft tissuesSkeletal, Dentoalveolar and Soft tissues changes with the standard bionatorchanges with the standard bionator.(Varun.(Varun Kalra AJO-95)Kalra AJO-95) Skeletal changes-Skeletal changes- Mandible-pt.B is moved forwardMandible-pt.B is moved forward  -length of mandible (Ar-Go) is increased-length of mandible (Ar-Go) is increased Dentition-Dentition- Overjet and overbite is decreasedOverjet and overbite is decreased Soft tissuesSoft tissues-- Facial convexity is decreasedFacial convexity is decreased Uncurling of the lower lip.Uncurling of the lower lip.www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Changes in soft tissue profile following treatmentChanges in soft tissue profile following treatment with bionatorwith bionator A.O. 1995A.O. 1995  Decreased skeletal convexity;Decreased skeletal convexity;  Increased anterior and posterior faceIncreased anterior and posterior face heights;heights;  Reduced overjet and overbite;Reduced overjet and overbite;  Decreased facial convexity;Decreased facial convexity;  Uncurling and increase in length of theUncurling and increase in length of the lower lip;lower lip;  Minimal effect on the upper lip.Minimal effect on the upper lip.www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. FRANKEL APPLIANCEFRANKEL APPLIANCE Introduced by FRANKEL in the yearIntroduced by FRANKEL in the year 19661966 PhilosophyPhilosophy  Vestibular arena of operations.Vestibular arena of operations.  Sagittal correction via tooth borneSagittal correction via tooth borne maxillary anchorage.maxillary anchorage.  Minimal maxillary basal effect.Minimal maxillary basal effect.  Lip pads, buccal shields and periostealLip pads, buccal shields and periosteal pull.pull. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. Mechanism of action:Mechanism of action: This appliance is used as oral gymnasticThis appliance is used as oral gymnastic appliance to help in overcoming abnormalappliance to help in overcoming abnormal perioral muscle activity and rehabilitates theperioral muscle activity and rehabilitates the muscles and to establish proper lip seal.muscles and to establish proper lip seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. TWIN BLOCK:TWIN BLOCK:  Introduced by William Clark(1977)Introduced by William Clark(1977)  Mechanism of actionMechanism of action :: Forces of occlusion are used as functionalForces of occlusion are used as functional mechanism to correct malocclusion.mechanism to correct malocclusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. MANDIBULAR GROWTH ADVANCERMANDIBULAR GROWTH ADVANCER :: INTRODUCED BY YOKOTA IN THE YEARINTRODUCED BY YOKOTA IN THE YEAR 1993.1993. It advances the mandibleIt advances the mandible progressively with a splint, with theprogressively with a splint, with the objective of remodelling the condyle andobjective of remodelling the condyle and the glenoid fossa in the TMJ.the glenoid fossa in the TMJ. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. Advantage:Advantage: Since this appliance is simple, it canSince this appliance is simple, it can be used concomitantly with a fixedbe used concomitantly with a fixed appliance. Thus tooth irregularity can beappliance. Thus tooth irregularity can be corrected simultaneously with thecorrected simultaneously with the correction of the skeletal discrepancy.correction of the skeletal discrepancy. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. Permanent dentitionPermanent dentition FFA comes to play in adolescent.FFA comes to play in adolescent. A complete FFA cannot be used in theA complete FFA cannot be used in the mixed dentition period.mixed dentition period. In permanent dentition, there is no reasonIn permanent dentition, there is no reason to delay aligning the teeth , and a growthto delay aligning the teeth , and a growth modification that makes this difficult ormodification that makes this difficult or impossible is s disadvantage.impossible is s disadvantage. www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. Growth modification with FIXEDGrowth modification with FIXED functional appliancesfunctional appliances In adolescent, often a fixed functionalIn adolescent, often a fixed functional appliance that allows brackets on the incisorappliance that allows brackets on the incisor teeth is the best choice.teeth is the best choice. Fixed functional appliances can be classified asFixed functional appliances can be classified as eithereither  Flexible (Flexible Fixed Functional Appliance)Flexible (Flexible Fixed Functional Appliance)  Rigid (Rigid Fixed Functional Appliance -Rigid (Rigid Fixed Functional Appliance - RFFA).RFFA).  HYBRID APPLAINCESHYBRID APPLAINCES www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. Flexible fixed functional appliancesFlexible fixed functional appliances  Jasper JumperJasper Jumper  Amoric torsion coilsAmoric torsion coils  Adjustable bite correctorAdjustable bite corrector  Scandee tubular jumper.Scandee tubular jumper.  Klapper super spring IIKlapper super spring II  Bite fixerBite fixer  Churro jumperChurro jumper www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. JASPER JUMPERJASPER JUMPER Advantages: 1.Ease of insertion and activation. 2.Generation of the intrusive forces on molars and incisors Introduced by J.J. Jasper 1980 www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. Disadvantages include:Disadvantages include:  Large inventory five sizes of left and right.Large inventory five sizes of left and right. Breakage and a lack of force when theBreakage and a lack of force when the mouth is held open slightly.mouth is held open slightly. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. THE AMORIC TORSION COILSTHE AMORIC TORSION COILS Introduced by AMORIC. M IN 1994Introduced by AMORIC. M IN 1994 www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. ADJUSTABLE BITEADJUSTABLE BITE CORRECTORCORRECTOR Introduced by RICHARD P. WEST 1995Introduced by RICHARD P. WEST 1995 This is an appliance which is assembledThis is an appliance which is assembled by the orthodontist as it is composed ofby the orthodontist as it is composed of various pieces – caps, closed coil springs,various pieces – caps, closed coil springs, nickel titanium wire.nickel titanium wire. www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. SCANDEE TUBULAR JUMPERSCANDEE TUBULAR JUMPER  (Saga Dental AS, 2201 Kongsvinger, Norway).(Saga Dental AS, 2201 Kongsvinger, Norway). www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Klapper SUPER Spring IIKlapper SUPER Spring II  Introduced by Lewis Klapper, 1999Introduced by Lewis Klapper, 1999  The SUPER spring II has proven to be excellentThe SUPER spring II has proven to be excellent for TMD patients who require orthodonticfor TMD patients who require orthodontic treatment after splint therapytreatment after splint therapy.. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. BITE FIXERBITE FIXER (Ormco 1717 West Collins Avenue, Orange,(Ormco 1717 West Collins Avenue, Orange, CA 92867)CA 92867) This is a new inter maxillary spring coil.This is a new inter maxillary spring coil. The spring is attached and crimped to theThe spring is attached and crimped to the end fitting to prevent breakage betweenend fitting to prevent breakage between the spring and the end fitting.the spring and the end fitting. Polyurethane tubing is inside the spring toPolyurethane tubing is inside the spring to prevent it from becoming a food trap .prevent it from becoming a food trap . www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. CHURRO JUMPERCHURRO JUMPER Introduced by Castañon R. et al., 1998Introduced by Castañon R. et al., 1998 www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. Rigid Fixed Functional Appliances.Rigid Fixed Functional Appliances. 1.Herbst appliance1.Herbst appliance 2. Cantilever bite jumper2. Cantilever bite jumper 3. Malu herbst appliance3. Malu herbst appliance 4.Flip lock herbst appliance4.Flip lock herbst appliance 5. The ventral telescope5. The ventral telescope 6. The magnetic telescopic6. The magnetic telescopic www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. 7. The mandibular protraction appliance7. The mandibular protraction appliance 8The universal bite jumper8The universal bite jumper 9.The biopedic appliance9.The biopedic appliance 10. Mandibular anterior repositiong10. Mandibular anterior repositiong applianceappliance 11. RITTO appliance11. RITTO appliance 12.SABBAGH UNIVERSAL spring12.SABBAGH UNIVERSAL spring www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. THE HERBST APPLIANCETHE HERBST APPLIANCE Introduced by Emil Herbst in the year 1907 Popularized by PANCHERZ Mechanics: Bilateral telescopic mechanism advancing the mandible into a new position www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. HERBST APPLIANCEHERBST APPLIANCE TREATMENT EFFECTS OF HERBSTTREATMENT EFFECTS OF HERBST DENTAL CHANGESDENTAL CHANGES The mandibular teeth are moved anteriorlyThe mandibular teeth are moved anteriorly Mandibular incisors are proclinedMandibular incisors are proclined Maxillary teeth are moved posteriorlyMaxillary teeth are moved posteriorly Maxillary teeth are distalized as well asMaxillary teeth are distalized as well as intrudedintruded www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. THE VENTRAL TELESCOPETHE VENTRAL TELESCOPE  This was the first telescopic RFFA that appeared as aThis was the first telescopic RFFA that appeared as a single unit; i.e. upon reaching maximum opening it doessingle unit; i.e. upon reaching maximum opening it does not come apart .not come apart .  Its disadvantages lie in the fact that it is quite thick andIts disadvantages lie in the fact that it is quite thick and suffers from fractures to the brake which stabilizes thesuffers from fractures to the brake which stabilizes the joint. As with the other appliances where fixing isjoint. As with the other appliances where fixing is achieved through ball attachments, great accuracy isachieved through ball attachments, great accuracy is necessary with regard to inclination and the welding ofnecessary with regard to inclination and the welding of components.components. www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. THE MAGNETIC TELESCOPICTHE MAGNETIC TELESCOPIC DEVICEDEVICE This appliance has the advantage ofThis appliance has the advantage of linking a magnetic field to the functionallinking a magnetic field to the functional appliance. Its main disadvantages are itsappliance. Its main disadvantages are its thickness, the laboratory work necessarythickness, the laboratory work necessary to prepare it and the covering of theto prepare it and the covering of the magnets.magnets. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. THE UNIVERSAL BITETHE UNIVERSAL BITE JUMPER(UBJ)JUMPER(UBJ) (Calvez X., 1998).(Calvez X., 1998).  This is like a Herbst but is smaller in size andThis is like a Herbst but is smaller in size and more versatile – it can be used in all phases ofmore versatile – it can be used in all phases of treatment in mixed or permanent dentition, Classtreatment in mixed or permanent dentition, Class II or III malocclusions.II or III malocclusions.  UBJs with nickel titanium coil springs do notUBJs with nickel titanium coil springs do not need to be reactivatedneed to be reactivated www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. THE BIOPEDIC APPLIANCETHE BIOPEDIC APPLIANCE Designed by Jay Collins in 1997Designed by Jay Collins in 1997 www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. The Mandibular AnteriorThe Mandibular Anterior Repositioning Appliance (MARARepositioning Appliance (MARA Introduced by Douglas Toll of Germany inIntroduced by Douglas Toll of Germany in 1991.1991. Mechanics: Bilateral cams fitted to molar stainless steel crowns to advance mandible www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. SABBAGH UNIVERSAL SPRINGSABBAGH UNIVERSAL SPRING Is ideal for treating patients withIs ideal for treating patients with  Insufficient cooperationInsufficient cooperation  Late cases with little remainingLate cases with little remaining growthgrowth  Illnesses of the upper respiratoryIllnesses of the upper respiratory tract system, such as asthmatract system, such as asthma  Patients who are allergic to plasticsPatients who are allergic to plastics www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. RITTO APPLIANCERITTO APPLIANCE The Ritto Appliance can be described as aThe Ritto Appliance can be described as a miniaturized telescopic device withminiaturized telescopic device with simplified intra oral application andsimplified intra oral application and activation The construction of thisactivation The construction of this appliance is based on the mechanism andappliance is based on the mechanism and function used in the Ventral Telescopefunction used in the Ventral Telescope adapted for use in conjunction with a fixedadapted for use in conjunction with a fixed applianceappliance www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. HYBRID APPLIANCESHYBRID APPLIANCES  The calibrated force module.The calibrated force module.  Eureka spring.Eureka spring.  The twin force bite corrector.The twin force bite corrector.  FORSUS Nitinol flat spring.FORSUS Nitinol flat spring. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. THE CALIBRATED FORCETHE CALIBRATED FORCE MODULEMODULE  It was a fixed appliance designed to substituteIt was a fixed appliance designed to substitute Class II elastics and it was developed in 1988Class II elastics and it was developed in 1988 by the CorMar Inc.by the CorMar Inc.  Its coil spring produced a force of 150 gmsIts coil spring produced a force of 150 gms www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. EUREKA SPRINGEUREKA SPRING This appliance appeared on the marketThis appliance appeared on the market in 1996 and it was developed byin 1996 and it was developed by DeVicenzo and Steve Prins .DeVicenzo and Steve Prins . Mechanics: Telescopic rods with integral light force compression springs. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. FORSUS NITINOL FLATFORSUS NITINOL FLAT SPRINGSPRING The Forsus Nitinol Flat Spring is slim,The Forsus Nitinol Flat Spring is slim, flat and made of Super-Elastic Nitinol.flat and made of Super-Elastic Nitinol. Nitinol is always at work, deliveringNitinol is always at work, delivering consistent forces. Force levels remainconsistent forces. Force levels remain constant from the initial setup to theconstant from the initial setup to the time of removal.time of removal. www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. ALPERN CLASS II CLOSERSALPERN CLASS II CLOSERS It consists of a small telescopic applianceIt consists of a small telescopic appliance with an interior coil spring and two hookswith an interior coil spring and two hooks for fixing .for fixing . It functions in the same way as elasticsIt functions in the same way as elastics and, similarly, is fixed to the lower molarand, similarly, is fixed to the lower molar and to the upper cuspid.and to the upper cuspid. www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. DENTAL CLASS II – TREATMENTDENTAL CLASS II – TREATMENT OPTIONSOPTIONS MAXILLARY MOLARS MOVED FORWARD MESIAL IN ROTATION OF THE MAXILLARY MOLARS www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. MAXILLARY MOLARS MOVEDMAXILLARY MOLARS MOVED FORWARDFORWARD GOOD FACIAL PROFILE POOR FACIAL PROFILE MOLAR DISTALIZATION EXTRACTION PROXIMAL STRIPPING 14, 24, 35, 45 AND FINISH THE CASE IN CLASS I 14, 24, AND FINISH THE CASE IN CLASS II www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. A number of appliances have beenA number of appliances have been introduced for molar distalisation.introduced for molar distalisation. CLASSIFICATIONCLASSIFICATION EXTRA ORALEXTRA ORAL Head gears--- a. cervicalHead gears--- a. cervical b. occipitalb. occipital INTRA ORALINTRA ORAL RemovableRemovable Fixed------------- Buccally actingFixed------------- Buccally acting Palatally actingPalatally acting www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. Buccally actingBuccally acting Super elastic Niti.Super elastic Niti. Niti coil spring.Niti coil spring. Jones Jig.Jones Jig. Lokars Appliance.Lokars Appliance. Wilson rapid molar distalising appliance.Wilson rapid molar distalising appliance. www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. Wilson rapid molar distalising appliance.Wilson rapid molar distalising appliance. K loop distaliser.K loop distaliser. Magnets.Magnets. C space regainer.C space regainer. Molar distalisation splint.Molar distalisation splint. CARIERE distaliserCARIERE distaliserwww.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. Palatally actingPalatally acting  Distal jet applianceDistal jet appliance  Cricket applianceCricket appliance  Nance applianceNance appliance  Pendulum appliance and its modificationPendulum appliance and its modification  Simple molar distaliserSimple molar distaliser  Intra oral bodily distalising applianceIntra oral bodily distalising appliance www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. MESIAL IN ROTATIONMESIAL IN ROTATION Often, in a class II malocclusion,Often, in a class II malocclusion, the maxillary first molars are rotatedthe maxillary first molars are rotated mesiolingually. Correcting this rotationmesiolingually. Correcting this rotation moves the buccal cusps posteriorly andmoves the buccal cusps posteriorly and provides at least a small space mesial toprovides at least a small space mesial to the molars.the molars. Cetlin, JCO, 1988 www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Treatment plan – molar rotationTreatment plan – molar rotation Transpalatal archTranspalatal arch Tip back bendTip back bend Nance palatal archNance palatal arch Head gearHead gear Couple forceCouple force www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. GROWTH COMPLETEDGROWTH COMPLETED CAMOUFLAGE SURGICAL www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. CAMOUFLAGE TREATMENTCAMOUFLAGE TREATMENT Beyond the adolescent growthBeyond the adolescent growth spurt to correct a skeletal problem teethspurt to correct a skeletal problem teeth should be displaced relative to theirshould be displaced relative to their supporting bone to compensate for thesupporting bone to compensate for the underlying jaw discrepacy. This is termedunderlying jaw discrepacy. This is termed camouflage treatment.camouflage treatment. www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. Indications for class II camouflage treatment:Indications for class II camouflage treatment:  Too old for successful growth modification.Too old for successful growth modification.  Mild to moderate skeltal class II.Mild to moderate skeltal class II.  Reasonably good alignment of teeth.Reasonably good alignment of teeth.  Good vertical facial propotionsGood vertical facial propotions www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. Extractions in class II:Extractions in class II:  Extraction of upper first bicuspids only withExtraction of upper first bicuspids only with lower non extractionlower non extraction  Extraction of upper first bicuspids andExtraction of upper first bicuspids and lower second bicuspidslower second bicuspids  Extraction of upper and lower bicuspids inExtraction of upper and lower bicuspids in cases with severe lower crowdingcases with severe lower crowding  Distalization of molars with second molarDistalization of molars with second molar extraction.extraction. www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. SURGICAL TREATMENTSURGICAL TREATMENT SURGICAL POST SURGICAL PRESURGICAL www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. PRESURGICALPRESURGICAL  TO REMOVE THE DENTAL COMPENSATIONSTO REMOVE THE DENTAL COMPENSATIONS THAT HAVE OCCURRED TO MASK THETHAT HAVE OCCURRED TO MASK THE SKELETAL MALOCCLUSION AND TOSKELETAL MALOCCLUSION AND TO FACILITATE THE SURGICAL PROCEDUREFACILITATE THE SURGICAL PROCEDURE  EXTRACTION PATTERN FOLLOWEDEXTRACTION PATTERN FOLLOWED ACCORDING TO THE CLINICAL SITUATIONACCORDING TO THE CLINICAL SITUATION  TO CORRECT THE AXIAL INCLINATION OF THETO CORRECT THE AXIAL INCLINATION OF THE ANTERIORSANTERIORS  TO BRING THE MOLARS TO FULL CUSP CLASSTO BRING THE MOLARS TO FULL CUSP CLASS IIII  TO CREATE SUFFICENT OVERJETTO CREATE SUFFICENT OVERJET  –– 15, 25 AND 34 AND 4415, 25 AND 34 AND 44www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. SURGICAL PROCEDURES:SURGICAL PROCEDURES: In case of,In case of,  Maxillary excess- Le Fort I OsteotomyMaxillary excess- Le Fort I Osteotomy  Mandibular deficiency- Saggital splitMandibular deficiency- Saggital split osteotomyosteotomy  Deficient chin- Advancement genioplasty.Deficient chin- Advancement genioplasty. www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. POST SUGICALPOST SUGICAL ORTHODONTICSORTHODONTICS Can be initiated 3 to 4 weeks afterCan be initiated 3 to 4 weeks after the release of immobilization. Stabilizationthe release of immobilization. Stabilization arch wires are removed and replaced byarch wires are removed and replaced by working arch wires with light vertical forcesworking arch wires with light vertical forces till a good stable occlusion is achieved.till a good stable occlusion is achieved. www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. CONCLUSIONCONCLUSION WITH SUCH A WIDE RANGE OFWITH SUCH A WIDE RANGE OF TREATMENT MODALITIES ANDTREATMENT MODALITIES AND APPLIANCES LISTED OUT FOR CLASSAPPLIANCES LISTED OUT FOR CLASS II MALOCCLUSION, IT IS AT THEII MALOCCLUSION, IT IS AT THE HANDS OF A SKILLEDHANDS OF A SKILLED ORTHODONTIST TO APPROPRIATELYORTHODONTIST TO APPROPRIATELY TIME AND CHOOSE THE RIGHTTIME AND CHOOSE THE RIGHT TREATMENT ACCORDING TO THETREATMENT ACCORDING TO THE INDIVIDUAL PATIENT NEEDS.INDIVIDUAL PATIENT NEEDS. www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. THANK YOU www.indiandentalacademy.comwww.indiandentalacademy.com For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com

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